Patients sometimes ask, “Is fertility treatment painful?” It’s a reasonable question. I know that before I personally undergo any medical procedure, I would want to know that. To better answer this question, I’ve taken an informal survey of my patients who did IVF and asked them to share about their experiences. As can be expected, there were a range of answers. However, the overall agreement, with a few rare exceptions, is that the physical pain associated with their IVF cycle was minimal. By the way, note that we’re talking now only about the physical pain, not the financial and emotional pain (if the cycle fails).

There are several potential sources of pain during an IVF cycle. The first starts out way before the actual egg retrieval. In preparation for the egg harvest, it is standard to take injectable medications to help develop the eggs. These are done with small needles and modern injection pen devices. Almost everyone dreads the first injection just out of fear about the unknown, but after the initial anxiety is over, most women report that the injection pain is nothing. The needles are tiny and go in fast and easy. Compare this to if you had diabetes. In that case, you would be injecting yourself with similar needles many times a day.

The next potential source of pain comes as the eggs develop, when the ovaries start to enlarge, causing bloating. This is a very real phenomenon, and there’s little that can be done about it other than to limit the number of eggs that we grow. Of course, this is a tradeoff, because if you only have 4-5 eggs, the pain and bloating are minimal, but your success rate is going to be decreased. This is the part most women hate, but in reality, most women with a well-controlled stimulation don’t even experience any real pain, but merely significant bloating, which itself can be quite uncomfortable. This discomfort can extend well into the week after the egg retrieval.

The third phase where there could be potential pain comes on the day of the egg retrieval itself. Knowing full well that the eggs are removed by piercing a thin long needle through the walls of the vagina into the ovaries, many women anticipate great pain on that day. But in reality, the pain is zero during the procedure, thanks to the wonders of modern anesthesia. In our program, we have anesthesiologists on hand for every retrieval in order to keep our patients pain-free and breathing normally with normal heart rates and normal blood pressures throughout the case. Some places around the country still do their retrievals without full anesthesia. While this is a cost savings, on the surface, there is a price with regards to patient comfort and the ability to successfully harvest each egg. Way back during my training at UCLA, we used to do these cases under sedation-only and it added to the difficulty of the egg retrieval when patients would occasionally twitch or move. It’s not that hard to aim a needle into a follicle, but it becomes way trickier when your target is moving.

Either three days or five days after the eggs are retrieved, the embryos are transferred back into the uterus. The transfer itself is almost painless, but it is as uncomfortable as a Pap smear.

After the retrieval, patients begin on progesterone, which is an injection, but different from the stimulation medications. Since it is an oil-based injection, the needle is larger and therefore more painful. The opinion on this is variable with some patients reporting a lot of pain while some find it quite tolerable. The ones who really find it unbearable have the option of taking their progesterone in other non-injection forms, such as with vaginal creme or vaginal suppositories.

So in summary, with regards to physical pain, while IVF has the potential to be painful in a few phases, in actuality, there is minimal pain for most patients.

However, nine months later, there is the much greater pain of childbirth and the postpartum period, which far surpasses any pain of the IVF cycle. The consolation is that this great pain is followed by the reward of motherhood

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